Abstract
IntroductionMyasthenia gravis is a rare neuromuscular disorder associated with a reduction in the availability of acetylcholine receptors at the post-synaptic membranes of skeletal muscles. This is caused by the production of anti-acetylcholine receptor antibodies at the neuromuscular junction due to an autoimmune insult, leading to a compromised neuromuscular transmission. Verapamil can influence, in a dose-dependent fashion, the neuromuscular transmission in myasthenia gravis.Case presentationWe report a 71-year-old Caucasian man with myasthenia gravis suffering from a cardiogenic shock following a single dose of verapamil. The patient had uncontrolled atrial fibrillation with a heart rate of 120 beats/min. Atenolol 100 mg was started. The next day, verapamil SR 240 mg was started. Two hours after the first dose of verapamil, the patient complained of weakness and dyspnea with signs of shock; his blood pressure was 70/50 mm Hg and heart rate at 101 beats/min. An echocardiogram showed diffuse hypokinesis of both ventricles with an ejection fraction of 20%. Cardiac catheterization was performed and coronary arteries appeared without significant stenosis, but there was a diffuse hypokinesis. Verapamil was stopped and the patient received intravenous glucagon and calcium chloride. Both the anti-acetylcholine receptor and anti-striated muscle antibodies tested positive. A few hours later, another echocardiogram showed an improvement in the ventricular function, which returned to normal five days later.ConclusionCaution is needed when administering verapamil to patients with myasthenia gravis, especially when the anti-acetylcholine receptor and anti-striated muscle antibodies titres are positive.
Highlights
Introduction: Myasthenia gravis is a rare neuromuscular disorder associated with a reduction in the availability of acetylcholine receptors at the post-synaptic membranes of skeletal muscles
Case presentation: We report a 71-year-old Caucasian man with myasthenia gravis suffering from a cardiogenic shock following a single dose of verapamil
Journal of Medical Case Reports 2009, 3:8219 http://jmedicalcasereports.com/jmedicalcasereports/article/view/8219 acetylcholine receptors at the post-synaptic membranes of skeletal muscles. This is caused by the production of antiacetylcholine receptor antibodies (AchR-Ab) at the neuromuscular junction (NMJ) due to an auto-immune insult [2], leading to compromised neuromuscular transmission (NMT)
Summary
Myasthenia gravis (MG) is a rare (4 cases/100,000 individuals) neuromuscular disorder characterized by weakness and excessive fatigability of skeletal muscles following repetitive effort and slow recovery after exercise [1]. A few hours later, another echocardiogram was performed and there was an improvement in ventricular function, resulting in recovery of systolic blood pressure to between 125 and 130 mm Hg. Five days later, the ejection fraction had returned to normal as had as the patient’s electrocardiogram (Figure 1). Two hours after receiving his first dose of verapamil, the patient began to complain of weakness and dyspnea He presented with signs of shock with blood pressure at 70/50 mm Hg and heart rate at 101/minute. Cardiac catheterization was performed within minutes; coronary arteries appeared without significant stenosis, but there was a diffuse hypokinesis At this point, cardiogenic shock secondary to calcium channel blocker intoxication was suspected. One hundred percent oxygen administration was performed resulting in a saturation of 98% and a pCO2 to
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
